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Martin Estacio was shelling out $800 per month for a health plan that didn’t fit his two-state lifestyle.

The retired San Bernardino firefighter lives between Oklahoma and California. But his health insurance policy, purchased in Oklahoma, didn’t cover non-emergency care outside the state.

So Estacio dropped his plan this month and took a leap of faith. He joined Christian Healthcare Ministries (CHM), an alternative to health insurance that offers a religious approach to covering medical bills.

Health care ministries such as CHM are essentially cost-sharing programs. Members’ monthly fees are applied directly to other members’ medical bills, no matter where they live in the U.S. Members also pray for each other, and often send notes of support and encouragement.

“What led me to look into it was financial,” says Estacio, 58. “When I started to realize it’s based on biblical principles where you help your brother out, that’s what really clinched me.”

A health care sharing ministry is primarily a “community of faith,” says Michael Gardner, spokesman for Christian Care Ministry, which operates the Medi-Share program. Medi-Share has roughly 300,000 members as of June, he says.

But let’s be clear: Christian health care ministries are not insurance. You must attend church regularly. You must agree to abstain from certain behaviors, such as “sexual immorality” and drug abuse. Preventive care, routine prescriptions and mental health care may not be reimbursed. Forget about abortion. Coverage for your preexisting conditions will likely be limited — at least initially.

Estacio pays $150 per month for his membership, plus quarterly payments of about $30 that offer him a higher level of reimbursement.

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He’s responsible for the first $500 on each medical incident before the ministry’s sharing kicks in, but only for allowed services. CHM’s list of non-covered services includes “psychological treatment,” medical supplies and equipment, immunizations, maintenance prescriptions and bills related to drug abuse.

“You have to try to live a good lifestyle,” Estacio says. “You can’t be drinking and smoking. It’s on you.”

Membership in health care sharing ministries has ballooned since passage of Obamacare, in part because the health law provides an exemption for members. If you belong to a qualified health care sharing ministry, you don’t have to pay the Obamacare tax penalty for not having insurance.

There are more than 100 ministries across the U.S., though the vast majority are small Mennonite churches, says alliance President Dave Weldon, a doctor and former Florida congressman. The three largest ministries are CHM, Medi-Share and Samaritan Ministries International, he says.

All the ministries are Christian at this point, though Weldon says there’s an attempt to start a Jewish sharing ministry.

“It’s our Christian practice of how we bear one another’s burdens,” says James Lansberry, executive vice president of Samaritan Ministries, which has about 227,000 members nationwide.

Samaritan members, who share about $23 million a month, mail their monthly fees directly to other members facing medical bills, along with notes of support, Lansberry says.

Each ministry works differently, but you can generally expect to pay a monthly membership fee. You may be responsible for all of your own routine and preventive medical costs in addition to paying a set amount before reimbursements kick in.

“In effect, they become sort of like catastrophic programs,” Weldon says. “But that’s true for a lot of plans on the Obamacare exchanges as well.”

Unlike catastrophic insurance plans, there’s no contract with health care sharing ministries, he says. That means there’s no guarantee that your bills will be covered.

“However, most of them have always paid their members when they have medical bills,” Weldon says.

“If you’re fairly young and fairly healthy, you may never face that,” says Janet Coffman, associate professor of health policy at University of California-San Francisco. But “some people have catastrophic illnesses that may cost millions of dollars.”

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